Social Security claims in Georgia

What you need to know If you are injured,  sick or suffer from any type of medical problem that leaves you unable to  work, you may be entitled to Social Security.  The Social Security system is  confusing, time consuming and sometimes unfair.  As lawyers, our goal is to  move your claim through the system and prepare your case for trial before a  Social Security judge.

We hope that the following questions and answers  will prove useful to you in better understanding how Social Security works.   To discuss your specific case, please call us at 770-393-4985.

What is Social Security Disability?  Back to Top

Most people are aware that the Social Security Administration is a part of  the federal government and that it pays older, retired people monthly checks.  What you may not realize, however, is that the Social Security Administration  also issues monthly checks to disabled children and disabled adults less than 62  years of age.

In order to be eligible for Social Security disability, you must be  "disabled." For Social Security purposes, a person is "disabled" if he/she has a  medical problem that prevents that person from working. In addition, the medical  problem must be severe enough that it will last at least a year.

As a practical matter, I can tell you that Social Security disability is  primarily about a person's ability to work. Stated another way, in order to  prove that you are disabled, you often need to prove that you cannot work even a  simple, unskilled job. For example, imagine yourself working as an packer, where  you sit at a table and pack items in a box; imagine yourself as a cashier at a  parking lot; imagine yourself as a nighttime security system monitor. Could you  perform one of these very simple, low stress, low exertion jobs 8 hours a day, 5  days a week?

As you might expect, your statement that you could not perform even a simple,  unskilled job is not enough. You probably will need an opinion from a doctor to  back you up. My job, as your Social Security attorney, is fairly simple. I have  to explain why you cannot work and gather evidence (medical records, employment  records) that identify specific job limitations.

How do I apply for Social Security?  Back to Top

It is easy and free to apply for Social Security. All you have to do is call  Social Security, toll-free, at 800-772-1213. You can also apply in person at  your local Social Security office. When you apply, I recommend that you tell the  person who answers the phone that you want to apply for both Disability and SSI.  When the Social Security employee asks you when you became disabled, you should  give the earliest possible date that you think you became unable to work (we can  always amend your "onset date").  You can use our new client intake form to organize the information you will need to give Social Security.

What is the difference between Disability and  SSI? Back to Top

You will be eligible for Disability if you are now disabled, but worked in  the past and paid Social Security taxes. Your work history must be fairly recent  and longstanding. There are many rules that determine whether you are eligible  for Disability - one of the things I do when I take a case is to request your  earnings and benefit statement - this will tell me if you have paid enough  Social Security taxes to be "insured" for Disability. The general rule (there  are many exceptions) is that you must have worked and paid Social Security taxes  for five out of the last ten years.

You can be eligible for SSI (supplemental security income benefits) if you  are disabled, even if you have never worked. You must show Social Security that  you have very low household income and very minimal resources. If your spouse  works, for example, you probably have too much income for SSI. In other words,  SSI is a problem for disabled people who are poor. One of the services I offer  my clients is counseling regarding how to characterize loans or other support  from family members. If you are not careful, Social Security will reduce your  SSI check by the "value" of rent, food and other living expenses provided to you  by parents or other family members.

You can be eligible for both Disability and SSI although your total check  will be the higher of the two - you do not get two checks.

How much will I get if I am approved?  Back to Top

Disability benefits are calculated based on how much you earned when you were  working and how much you paid into the system. I have seen Disability checks as  low as $100 per month and as high as $1,800 per month. The typical Disability  check I see is about $1,100 per month, but yours may be higher or lower.

SSI benefits are set by law and change every year. If you have no offsets,  your SSI check will be around $515 per month.

As you can see, Social Security benefit payments are not large, especially in  comparison to what you can earn if you are able to work.

What are "back benefit checks" or "lump sum  payments"? Back to Top

You may know friends or relatives who have received large, lump sum payments  from Social Security. These lump sum payments represent past due benefits.  People receive past due benefits because it takes so long for claims to work  their way through the system. For example, in the Atlanta area, it can take two  to three years from the time a person applies until he is approved and receives  his check. It takes this long because Social Security Administration employees  are overworked and because thousands upon thousands of people apply every day  and each claim must be evaluated.

Why would I want to hire an attorney and how much will it  cost?  Back to Top

An experienced lawyer can be very helpful to you in many ways. First, as your  lawyer I can make sure that you have applied for all disability programs for  which you are eligible. For example, I have seen claimants whose Disability  applications were not processed by Social Security, or whose applications were  lost. In several cases, I have been able to argue that the mere evidence of a  communication with Social Security is enough to prove that an application was  filed, thereby preserving my client's rights.

As your lawyer, I can determine if you are eligible to "reopen" old  applications. In some cases, a prior application, even one filed three or four  years earlier, can be reopened, thereby making you eligible for years of back  benefits. If you ever filed an old application, or even if you simply called  Social Security to inquire about benefits, you could lose thousands of dollars  if you fail to look into reopening an old application.

As your lawyer, I can evaluate your case and suggest a strategy to win your  case. After handling hundreds of cases, I have a fairly good perspective as to  what cases are winnable and what cases are not, and what it takes to win a case.  While my opinion is not a determination of how your case will end up, I can  offer you the benefit of my experience. More importantly, if you decide to hire  me, I will make sure that your case file is up-to-date with all medical records.  In addition, I will work with your doctors to "translate" your medical problems  into work limitations so that Social Security can evaluate your claim  properly.

If you choose to hire me, I handle most cases on a "contingency" basis,  meaning that I am paid only if I win. My fee is typically 25% of any past due  benefits I can collect for you.

How is my case decided - will I have to appear before a  Judge?  Back to Top

The Social Security decision-making process is unwieldy and time-consuming.  When you first file (your initial application), your case is opened by an office  called the Disability Adjudication Section (the D.A.S.) which is part of the  State, not Federal, government. The D.A.S. adjudicator will interview you and  request medical records from your physicians. After about 3 months, the  adjudicator will issue a decision.

It has been my experience that D.A.S. adjudicators are often overworked and  unable to spend the time necessary to develop your case file. In addition, by  law, adjudicators have specific guidelines that they must follow when evaluating  your case. For this reason, many deserving cases are denied at the initial stage  because records were simply not returned by doctors or because a medical record  does not contain language discussing work activity limitations. Although Social  Security is working to change the D.A.S. position, most claimants never have the  opportunity to speak with the adjudicator deciding their case, and most  adjudicators are too busy to spend as much time as they might want to analyze  each case.

The D.A.S. adjudicator's decision denying your case is mailed to you in a  letter that briefly explains why you were denied. This letter also advises you  that you have 60 days to appeal, although the appeal forms are not mailed to  you. If you follow-up with Social Security, you (usually) will be provided with  an appeal form called a Request for Reconsideration and a 6 page Reconsideration  Disability report. As you might imagine, many claimants fail to appeal, and  those that do often find the lengthy paperwork difficult to complete.

If you complete your Reconsideration paperwork, it is sent back to the D.A.S.  where another adjudicator reviews your file. It has been my experienced - and  this is backed up by Social Security statistics - that very few cases are  reversed at Reconsideration. The Reconsideration process takes about three to  four months.

If your case is denied at Reconsideration, the Adjudicator's decision denying  your case will be mailed to you with a brief explanation and a notice that you  can appeal by requesting a hearing within 60 days. Again, no hearing request  paperwork is enclosed, although it will be sent to you if you ask.

If you request a hearing, you will receive an acknowledgment and a letter  advising you that you can expect to wait about a year. During this year, your  file will be transferred from the D.A.S. to the Social Security hearing office  called the Office of Hearings and Appeals (the O.H.A.). After about a year, you  may receive a notice from the Judge to whom your case is assigned advising you  that your file is being worked up. Thereafter, you will receive a hearing notice  setting the time and place for your hearing.

I get involved in cases at all levels of this process, although most of my  clients hire me after receiving their initial denial. Many clients feel more  comfortable having my firm complete and submit the appeal paperwork within the  60 day deadline. In addition, as noted above, I make sure that your medical  record, including recent treatment, is sent to the Adjudicator or the Judge at  the correct address prior to the hearing. Most importantly, I identify a  strategy to win your case and obtain forms, letters or other documents from  physicians and others to prove your case.

Obviously, not all cases need to be heard by a Judge. It has been my  experience, however, that many seriously ill claimants will not be approved at  the initial or reconsideration adjudication level.

What kinds of cases are handled by Ginsberg Law  Offices?  Back to Top

Our firm handles many different kinds of disability cases. You can download our intake forms by clicking on the link.  Feel free to mail or fax us your intake form for a free telephone case evaluation.  Here are a few  typical case areas and how we approach them:

1. Mental Health cases - Mental illness and mental health problems can  strike people of any age or background. I have found that Judges accept as  disabling cases involving long term, severe depression, schizophrenia, bipolar  syndrome and other mental illnesses. A key to winning this type of case is to  show extended treatment, even if the counseling is with a County Health  Department. Psychiatric hospitalizations and suicide attempts are seen as strong  evidence of a significant problem. In mental health cases, Social Security  usually refers the claimant to an independent psychologist for a consultative  evaluation. Psychologists, like judges, see ongoing treatment as evidence of a  long-standing problem.

2. Back pain cases - It has been my experience that judges expect to  see objective evidence of back pain, specifically MRI evidence of significant  disc herniation. X-ray evidence is usually not very helpful, and chiropractic  treatment is given very little weight. In addition to objective evidence, I have  found that judges like to see evidence that a claimant has tried to work through  his pain - evidence of unsuccessful work attempts can include employment records  or statements from ex-co-workers or supervisors.

3. Diabetes - Diabetes is a very common disease and many people are  afflicted. As such, I have found that in order to win a case based on diabetes,  we must show severe complications, such as vision problems, organ damage (i.e.  kidney or liver), and/or peripheral neuropathy (numbness and burning in hands  and feet). I usually look for clients who have suffered with diabetes for many  years and who have been unable to control their blood sugar despite compliance  with regular medical care.

4. Arthritis - Like diabetes, arthritis is very common in the  population. The most common form of arthritis is osteoarthritis, which is  commonly associated with getting older. In order to win an osteoarthritis case,  I look for older clients with significant deformity in their hands, feet, knees  or spine and regular medical treatment. Other forms of arthritis, such as  rheumatoid arthritis, often strike younger people, and are often more severe.  Rheumatoid arthritis cases are usually strong cases.

5. HIV/A.I.D.S. - The Social Security regulations provide that HIV  cases should be granted when lab reports show very low T-cell levels. My  experience has been that most judges view HIV cases somewhat liberally and will  grant benefits even if the lab reports do not demonstrate full-blown A.I.D.S.  Many HIV cases also involve depression, which can provide another theory for  recovery. Again, regular treatment and a supportive treating physician is very  helpful.

6. Intestinal, stomach, liver and kidney diseases - It has been my  experience that internal organ diseases often produce very significant work  activity limitations. For example, a person with irritable bowel syndrome might  be able to function at work for a time, but would not be able to maintain  employment because of frequent absences or excessive unscheduled breaks at work.  A record of regular medical treatment and written support from a treating  physician are necessary.

How does age and education factor in to a Social Security  evaluation?  Back to Top

Social Security recognizes that the older a person is, the harder it will be  for that person to adjust to changes in the working world. Similarly, a  claimant's limited education or intellectual ability is a vocational factor. For  Social Security purposes, a claimant who is less than 50 years old is considered  a "younger individual" and is not entitled to any specific consideration due to  age. At age 50 and again at age 55, special rules making it easier to qualify  are put into place for claimants with physical impairments who have limited  schooling.

If you are 50 or older, I can advise you if these special rules, called the  "grids," apply to you.  Under the grids, if you are 50 years or older, your impairment is a physical problem and you have a limited formal education or no significant work skills, you can be found disabled even if there are some “sit-down” or “light” jobs you can still do.  The idea behind the grids is that people over 50 with limited work skills and education will have a more difficult time re-entering the work force.  Please ask if you want to know whether the grids apply to you.

What are the Social Security "listings" and where can I  find them?  Back to Top

As noted above, most Social Security cases are decided based on the work  activity limitations resulting from one or more medical problems. It is  possible, however, to win your Social Security case based solely on your medical  condition. Social Security publishes a handbook describing specific medical  problems and the level of severity you must show if you are to be declared  disabled. These list of medical conditions are called the "listings." The  listings describe major illnesses and conditions in various systems of the body  - for example there is a listing on the musculoskeletal system, the respiratory  system, mental health, cancer, etc. The listings are published in the Code of  Federal Regulations and can be found on the Web. It has been my experience that  in order to win a case on the listings, you will need extensive medical records  and, ideally, a statement or questionnaire on the listing completed by a  treating physician. At Ginsberg Law Offices, P.C., we have prepared  questionnaires on most of the listings, thereby enabling your doctor to answer  questions about the listings by checking off boxes or completing short answer  questions.

How will my workers' compensation case affect my Social  Security case?  Back to Top

Your worker's compensation case may have a very significant impact upon your  Social Security case. In terms of your benefits, your worker's compensation  payments may totally offset your Social Security payments - in this case, it may  not be possible for my office to handle your case on a contingency since there  may be no back benefits. In other cases, your worker's compensation settlement  can be structured as a lifetime pay out, thereby reducing or eliminating your  worker's compensation offset.

If you have a worker's compensation claim, it is crucial that you advise us  about it so we can properly advise you about Social Security. If you are not  represented by an attorney in your worker's compensation case, we offer our  clients the benefit of our expertise and experience in both worker's  compensation and Social Security Disability.

What if I have a Long Term Disability policy and am  receiving LTD benefits?  Back to Top

It has been my experience that most LTD carriers require claimants to apply  for Social Security since Social Security benefits can reduce the amount of  money that the LTD carrier must pay over the course of a claimant's lifetime. In  addition, the Medicaid and Medicare benefits that accrue to Social Security  beneficiaries can reduce the health insurance costs to a LTD carrier. Our office  has established ongoing relationships with most of the LTD carriers who issue  coverage in the Atlanta area. In most (but not all) situations, LTD carriers can  assist our office in obtaining Social Security benefits and the end result to  you will be the same or more monthly cash benefit. If you are covered by an LTD  policy, please let us know. 

Will I get Medicare or Medicaid if I win my Social  Security case?  Back to Top

As a general rule, you will be entitled to Medicaid as of your date of  entitlement for SSI. You will become eligible for Medicare 24 months (2 years)  after your date of entitlement for Disability.

What if I lose at the hearing? Is my case over?  Back to Top

If the Judge concludes that you are not disabled (an unfavorable decision),  or if the Judge finds you disabled, but at a later date than you contend (a  partially favorable decision), you can appeal the decision to the Appeals  Council. As before, your appeal must be filed within 60 days. Usually, the  Appeals Council will only consider legal challenges to the Judge's decision;  therefore, it is wise to have a lawyer prepare your Appeals Council brief. At  Ginsberg Law Offices, we sometimes accept Appeals Council cases from clients who  had another lawyer appear with them at the hearing, but we are very selective.  If you want my firm (or any other firm) to evaluate your Appeals Council case,  do not wait - the earlier we see the case, the better.

Summary  Back to Top

Social Security Disability and SSI are programs that provide monthly payments  to individuals who cannot work. If you have a serious medical problem, ongoing  medical treatment and/or a supportive doctor, and you cannot perform at a job,  we would be pleased to speak with you about Social Security Disability. Please feel free to fill out our online form, or fax us a completed intake form for a free case review.  There is  never a charge for phone calls and we are happy to answer your questions. Call Jonathan Ginsberg at 770-393-8963 or Jodi Ginsberg at  770-351-0801.

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